Functional Characteristics of Enterocystoplasty After Interruption of the Mesenteric Blood Supply

Abstract

Previous studies have suggested that small (5 to 7cm.) enteral patches used for bladder augmentation could remain viable following ligation of the mesenteric vascular pedicle. We performed subtotal cystectomy and ileocystoplasty in 5 female mongrel dogs using a 25cm. segment of detubularized ileum. Functional bladder capacity, compliance and size of the bowel segment were measured 4 months later, and the mesenteric blood supply was interrupted. Immediately after pedicle ligation all patches appeared dusky and had diminished or absent Doppler pulsations with poor fluorescein uptake. However, all animals had an uneventful postoperative course without any signs of urine leak or peritonitis. Urodynamic studies were performed 2 months later and the animals were re-explored with removal of the augmented bladder for histological examination. All of the bowel segments were viable on exploration at that time but a decrease in patch size was noted ranging from 9 to 63%. Functional bladder capacity was also decreased in 4 animals.Although the integrity of augmentation was maintained in all animals, changes in bladder capacity and size of the enteral segment occurred in the majority after interruption of the mesenteric blood supply. These changes could possibly negate the clinical benefits that had been achieved by the bladder augmentation. This finding would suggest the need to consider revision of the enterocystoplasty in the event of inadvertent ligation of the vascular pedicle.